The Controll storm Verapamil Inves...

The Controll storm Verapamil Investigation of Cardiovascular expiration Points (CONVINCE) trial was planned to establish the effectiveness of controlled-onset extended-release (COER) verapamil with standard therapy in preventing cardiovascular disease cessation points. The trial was stopped couple years early because the sponsor withdrew financial support.

CONVINCE was a large, randomized, double-blind, controll multicenter, international trial comparing COER verapamil with hydrochlorothiazide or atenolol. Primary [i]finale[/i] points included stroke, acute myocardial infarction, or cardiovascular-disease--related death. Secondary last points included heart failure, transient ischemic attack or carotid endarterectomy, hospitalization for angina, cardiac revascularization or transplant, renal failure, malignant hypertension, all-cause mortality, cancer, and hospitalization for bleeding (excluding hemorrhagic stroke)

The sample size was increased during the course of the trial to 16600 with a target of 2246 conclusions after researchers realized that the withdrawal rate from verapamil was greater than initial estimates. Equivalence bounces for the hazard ratio were prespecified as 086 to 116 In patients not achieving adequate house pressure control, the dosage could be increased, or hydrochlorothiazide or atenolol could be added to the assigned regimens in a blinded fashion. A third antihypertensive medication from another class could be added in a nonblinded fashion.

athwart the mean 2.2 years of the meditation period, both regimens lowered descendants pressure significantly. On average, systolic progeny pressure was reduced by 136 mm Hg and diastolic urgency by 7.8 mm Hg from baseline in patients receiving COER verapamil. In those receiving atenolol or hydrochlorothiazide, systolic and diastolic vital fluid pressures were reduced by 135 mm Hg and 71 mm Hg respectively. Differences in one as well as the other systolic and diastolic pressures between the sum of two units arms were small.

In the COER verapamil form into groups there were 364 first primary last points, and in the atenolol or hydrochlorothiazide cluster there were 365. The composite primary completion point hazard ratio for the COER verapamil clump compared with the atenolol or hydrochlorothiazide arrange was 1.02 (confidence interval, 95 percent) The hazard ratio for the primary completion point or cardiovascular-related hospitalization was 105 and for death, 108 Treatment hazard ratios were similar between the couple groups in terms of the time of day in which affairs occurred. In both groups, there was a predominance of primary occurrences in the period between 6 a.m. and noon.

The rises of this study show that COER verapamil is not equivalent to atenolol or hydrochlorothiazide in preventing cardiovascular disease--related consequences Because the trial was stopped early, fewer than undivided third of the planned number of ends were observed. In the adjoining matter of other trials, such as the Antihypertensive and Lipid-Lowering Treatment to impede Heart Attack Trial (ALLHAT), the data indicate that calcium channel blocker are similar to diuretics and beta blocker in reducing cardiovascular-disease--related morbidity and mortality on the other hand are not more effective than either.

Caroline Wellbery, MD

Black HR et al. Principal eventuates of the controlled onset verapamil investigation of cardiovascular conclusion points (CONVINCE) trial. JAMA April 23/30 2003;289:2073-82

COPYRIGHT 2003 American Academy of Family Physicians

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